Considerations for Trainers: Not All Injuries Are Created Equal

As a strength coach, it is almost inevitable that I will come across clients that have had injuries; sometimes multiple injuries. Clients whom have had surgeries often times experience a permanent loss in joint function. In these situations programs need to be modified in order for the client to receive the best training effect for their overall development. To preface the following information: We as coaches need to know WHEN to refer out and when to proceed with training. Often times, we can work around injuries through anecdotal research or protocols put forth by some of our leading physical therapists in the industry. However, there is NOT always a protocol that we can follow, and often times we have to rely on feedback from clients. There are some exercises that clients will simply not be able to perform, given their injury history. In this post I will be focusing on the knee in particularly, but by no means am I giving a protocol for success in training around knee injuries. This is strictly anecdotal feedback (years of feedback) that I have personally experienced dating back to 2003. Since 2003, I have had seven (yes, SEVEN) knee surgeries.

Before moving forward, let’s take a look at a condensed list of injuries (2003-2012).

Left Knee – 5 surgeries

  • Derangement of anterior horn of lateral meniscus
  • Chondromalacia patella
  • Grade IV Chondrolysis, lateral tibial plateau
  • Arthroscopic partial lateral meniscectomy
  • Athroscopic chondroplasty patella
  • Arthoscopic microfracture lateral tibial plateau
  • Degenerative joint disease

Right Knee – 2 surgeries

  • Arthroscopic removal of multiple loose bodies
  • Patellar shaving
  • Lateral anterior horn meniscectomy
  • Microfracture lateral tibial plateau

I think it’s pretty clear I’ve had some knee problems. I won’t go into detail with the actual injury mechanisms, but I’ll move forward with how I’ve designed a plan to train my lower body. The first step I took is recognizing my limitations. There are exercises that I cannot do; jumping, squatting to depth, single leg squat variations, and forward lunging. The following is a list of lower body exercises that I have found to be staples in my program.

1. Deadlift (Convential and Trap-Bar)

I find it interesting that if I do a body weight squat to depth I have knee pain, but I can trap bar deadlift 600 pounds!

The deep knee flexion during a squat to depth causes me to have knee pain. Is it really important to know the exact reasons? Probably not, but pain is usually a good indicator to steer clear of an exercise.

2. Barbell Bridges

Barbell bridges are a great way to train the posterior chain. I have found that pretension of the glutes helps aid in making it a glute dominant exercise. *Note-Video is of Bret Contreras (a.k.a, the Glute Guy).

3. Step-Ups (12-16 inch box)

Referring back to the discussions about deep knee flexion, I have found that I can go heavy on my step-ups to a small box.

4. RDL’s and SLDL’s

Straight leg dead lift variations are another way for me to train the posterior chain.

Ben Bruno showing off his variations of a single leg RDL.

5. Kettlebell Swings

Rounding off the list is the kettlebell swing. I find the use of kettle bell swings beneficial to my training because I can be explosive without having repeated blows to my knees. It has virtually no impact to the knee joint, as it is a hip dominant exercise.

The five exercises I listed are my “bread and butter” for lower extremity training. I think of this as a positive because I don’t have a huge list of exercises I could program. I know what works and I stick to them. Do I want to squat? Yes. Can I squat without pain? No. Therefore, I have cut ties with the squats…for now.

Making a Connection to Your Clients

If you’re going to be in this business and be a top strength coach, it is important to know how to train around clients with chronic injuries. Researching is a good start to designing a program (although all my personal evidence is anecdotal), as well as an assessment. However, feedback from the client can also help to determine how to program. Am I saying that the client dictates how you write a program? No, but you have to consider ways to train around pain. Each client is different, and even the world’s greatest physical therapists cannot come up with protocols for chronic dysfunctions, because not all injuries are created equal.

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